Alzheimer’s Disease, metabolic disorders and the role of diet

Accumulating evidence for the role of metabolic disorders such as insulin resistance, diabetes, obesity and hypertension in increasing the risk of Alzheimer’s disease and vascular dementia, is reviewed in a new paper published this month in the Archives of Neurology.

In the same journal, compelling evidence is presented that higher pre-diagnosis total cholesterol, low-density lipoprotein cholesterol, and diabetes are associated with faster cognitive decline in patients with incident Alzheimer’s disease.

A cohort of 156 patients with incident Alzheimer’s Disease (mean age 83 years) were followed for up to 10 years.  Changes in a composite score of cognitive ability were monitored from diagnosis onwards.

“These findings indicate that controlling vascular conditions may be one way to delay the course of Alzheimer’s, which would be a major development in the treatment of this devastating disease as currently there are few treatments available to slow its progression,”

said Yaakov Stern, Ph.D., a professor at the Taub Institute for the Research on Alzheimer’s Disease and the Aging Brain and director of the Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center at Columbia University Medical Center, and senior author of the paper.

“Preventing heart disease, stroke and diabetes – or making sure these conditions are well managed in patients diagnosed with them – can potentially slow the disease progression of Alzheimer’s,” said Dr. Stern.

Diets high in fruit, vegetables, fibre and unsaturated fats, and low in sugar, salt and saturated fat are known to reduce the risk of a range of chronic conditions, such as diabetes, heart disease and stroke.  This means eating more plant-based foods and less processed and animal-based foods.

Stabilising blood sugar is crucial.  This may be done by eating a diet with a low glycaemic load, that is, one that includes moderate quantities of complex carbohydrates which release glucose slowly into the bloodstream.  Whole grains, such as whole-wheat bread, brown rice, quinoa, millet and buckwheat are valuable for helping to ensure smooth regulation of blood sugar.  In contrast, highly refined carbohydrates, such as white bread, white rice, white pasta and table sugar, create a roller-coaster of blood sugar highs and lows, which if left unchecked, can ultimately give rise to insulin resistance and eventually to diabetes.  Potatoes release sugar into the bloodstream almost as fast as table sugar and thus should be eaten sparingly, unless you are lean and exercise regularly.  Consuming protein with carbohydrates at every meal has also been found to help regulation of blood sugar.

Increasing the quantity of vegetables and fruit in the diet is also vital.  Blood sugar levels are easier to maintain if vegetables are emphasized more than fruit, as some fruit contains a lot of sugar.  A minimum of 5 portions of fruit and vegetables per day is recommended.  For easy tips for increasing the amount of fruit and vegetables in your diet please click here.

Unsaturated fats found in plant oils, such as olive oil and the oils of nuts and seeds, and in oily fish, are beneficial for preventing heart disease and other vascular health conditions.  For practical suggestions for ways to incorporate more healthy unsaturated fats in your diet please click here.

For information and practical tuition in how to put all these recommendations together to create fabulous food that protects you from diabetes, heart disease and Alzheimer’s Disease, please come to a Cooking for Health course, run by nutrition expert, Dr Jane Philpott.

Long term health is affected by maternal nutrition

This month, the British Medical Association (BMA) Board of Science has published a report on Early Life Nutrition and Lifelong Health.  The report reviews the evidence that the diets of women of reproductive age, and those of their foetuses and young children, are significant factors in influencing the risk of chronic diseases such as heart disease, diabetes, obesity, brittle bone disease and even some forms of cancer and mental illness, later in those children’s lives.

Lead author Professor Mark Hanson, director of the Centre for the Developmental Origins of Health and Disease at the University of Southampton, comments:

“Society and public health organisations need to pay much greater attention to these issues if the rising epidemic of these diseases is to be prevented. Tackling the diseases once children reach adulthood is often too late. By taking steps to improve maternal nutrition we could save many people from a lifetime of ill health.”

Unbalanced nutrition can result from both inadequate and excessive dietary intakes, and both can exist at the same time in many populations. Moreover diets which lead to over-nutrition (e.g., excess calories) are often micronutrient poor.

There is strong evidence that undernutrition (stunting or wasting) during the first two years of life leads to impaired adult cognitive, physical and economic capacity, which cannot be repaired even if nutrition improves later in childhood.

Improved availability of energy-rich foods has however, enabled large numbers of people to escape from hunger. This has brought considerable benefits, but is already giving rise to obesity and obesity-related disease. Developing countries are reporting high rates of coronary heart disease (CHD) and type 2 diabetes that have appeared in one or two generations to become leading causes of morbidity and mortality. These epidemics are expected to intensify.  By the year 2030, the prevalence of diabetes is predicted to rise by over 100 per cent in India, China, sub-Saharan Africa, Latin America, the Caribbean and the Middle East; an increase far exceeding that in high-income countries (54%).

There is good evidence that an increased deposition of fat tissue in foetuses and babies is an outcome of both undernutrition and excessive nutrition.  Low birth weight babies born to underweight women in India have proportionately more fat than would be expected for their body weight.  Maternal obesity, another form of maternal malnutrition, also increases the fat tissue of the foetus and newborn baby. This phenomenon is exacerbated further if maternal obesity is complicated by gestational diabetes.

Extremes of maternal body composition, either excessive thinness or obesity, are associated with adverse patterns of foetal and infant development leading to poorer long-term health.

“It’s not only women who need to be careful about the quality of their food intake. Prospective fathers should also eat well and steps need to be taken to ensure that young people understand the importance of good nutrition as part of their lifestyle choices.”

The numbers of women who breastfeed their infants is still too low, with many women starting to breastfeed but then stopping too soon, and many infants being fed inappropriate foods at the weaning stage.  Breastfeeding rates in the UK are much lower than in many European countries. Less than1 per cent of mothers in the UK are exclusively breastfeeding at six months.

While there are gaps in the evidence about the long-term consequences of poor maternal and infant nutrition, and we do not as yet understand the mechanisms fully, it is clear that steps need to be taken to promote healthy diets in young women and their families, to encourage breastfeeding and the use of appropriate complementary foods.

More advice could be given to people with young children about the importance of a balanced diet for those children and more support could be given to women to help them start breastfeeding and to continue with it.

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Fruit and vegetable consumption low across the world

A new study to be published in the May edition of the American Journal of Preventive Medicine paints a depressing picture of the dietary habits of modern man across the globe.

National Diet and Nutrition Surveys in the UK have found that less than 15 per cent of the population eats the recommended 5 portions of fruit and vegetables per day; a similar situation exists in the USA.  It appears that the same is also true in developing countries, where traditional diets are threatened by the introduction of processed food.

A survey of over 200,000 people in developing countries showed that overall 77.6 per cent of men and 78.4 per cent of women consumed less than the suggested five daily servings of produce. 

“Low fruit and vegetable consumption is a risk factor for overweight and obesity, and adequate consumption decreases risk for developing several chronic diseases,” said lead author Spencer Moore. “The release of the 2002-2003 World Health Survey data provided a unique opportunity to examine global differences in low fruit and vegetable consumption in a way that has until now simply not been possible.”

There were wide variations among nations, ranging from 37 percent of men in Ghana who did not meet that standard – to 99 percent of Pakistani men. The researchers saw similar findings in women with the same two countries at the high and low ends of the spectrum.

The prevalence of low fruit and vegetable intake increased with age and decreased with income. This contrasts with findings from the UK where, on average, older people consume more fruit and vegetables than younger people.

Epidemiological studies show that societies consuming high quantities of fruit, vegetables and whole grains are at lower risk of developing chronic diseases such as diabetes, heart disease and cancers than those that consume low quantities.  Such societies are often, but not exclusively, in less economically developed parts of the world.  As GDP per capita increases, countries opt for eating more meat, more processed food and less fruit, vegetables and whole grains.  This dietary shift leads to an epidemiological shift – away from infectious diseases and other diseases associated with lack of food, towards chronic noncommunicable diseases such as heart disease, stroke and cancer. 

The decline in consumption of fruit and vegetables in developing countries is disturbing as it is likely to give rise to an increase in the incidence of chronic diseases, leading to huge burdens on the healthcare systems of those countries, which may be ill-equipped to cope.

For information and practical tuition in how to create mouth-watering dishes with locally produced fruit and vegetables, come along to Cooking for Health courses held throughout the year in Somerset, UK.

If you are a caterer, or a professional responsible for encouraging healthier catering practices in your community, you will benefit from participating in a two-day training course on Healthier Catering.   By the end of the course, participants will: 

• Understand the basic principles of nutrition
• Be aware of the importance of food in the maintenance of health and well-being
• Appreciate the role of lifestyles and culture in influencing diet
• Recognise the potential benefits for both caterers and customers of providing a choice of healthier options
• Know more about ingredient selection and methods of food production and processing that can be used to create healthier options, whilst being attractive and convenient to modern tastes and lifestyles
• Be able to apply appropriate and relevant skills and knowledge when advising catering businesses or when planning, preparing, promoting and serving healthier foods

For further details about the course content and the course tutor, Dr Jane Philpott, please see http://cookingforhealth-uk.com/healthier-catering.php.

Reference

Hall JN, et al. Global variability in fruit and vegetable consumption. Am J Prev Med. 36(5), 2009.

Over-eating when eating out

Recently, I gave the menu of a well-known chain restaurant to a group of students and asked them to select what they would eat if they were dining there. 

 

They selected a starter (garlic bread with cheese), a main course (traditional lasagne with a salad), a dessert (ice cream) and a drink (a can of coke). 

 

Using the restaurant’s own nutritional information, they calculated the nutrient content of what they had chosen (Table 1).  The results left the students open-mouthed.

 

Their menu selection had provided:

 

n 106% of the guideline daily amount of calories (assuming 2000 kcal per day);

n 141-171% of the guideline daily amount of protein (depending on whether they were male or female);

n 61% of the guideline daily carbohydrate;

n 109% of the guideline daily amount of total fat;

n 192% of the guideline daily amount of saturated fat

n 52% of the guideline daily amount of salt. 

 

It is worth noting that the dietary reference value for salt in the UK is 6 g per day, compared with 2.3 g per day in the USA.

 

Thus, one meal out would have provided more than the entire day’s requirement for calories; enough protein to last for one and a half days; and enough saturated fat to last for two days.

 

Most people have no idea of the nutrient content of the food they are eating, nor of the potentially damaging effects on their health of a dietary excess of sugar, saturated fat and salt. 

 

Given that at least one–third of household expenditure on food and drink is spent on food eaten outside the home in the UK, food manufacturers and caterers have a real opportunity to contribute to an improvement in public health whilst also making a profit themselves. 

 

There is now convincing research evidence to suggest that increasing the amount of fruit, vegetables and whole grains in the diet, whilst decreasing the amount of sugar, saturated fat and salt, helps to protect the body from chronic conditions such as obesity, type 2 diabetes, heart disease and various cancers.

 

A two-day professional training course is offered, tailored to equip caterers, and those involved in encouraging healthier catering practices, with information and practical tools to achieve healthier eating in the population.

 

By the end of the course, participants will:

• Understand the basic principles of nutrition
• Be aware of the importance of food in the maintenance of health and well-being
• Appreciate the role of lifestyles and culture in influencing diet
• Recognise the potential benefits for both caterers and customers of providing a choice of healthier options
• Know more about ingredient selection and methods of food production and processing that can be used to create healthier options, whilst being attractive and convenient to modern tastes and lifestyles
• Be able to apply appropriate and relevant skills and knowledge when advising catering businesses or when planning, preparing, promoting and serving healthier foods

For further information on the course content and the course tutor, Dr Jane Philpott, please click http://cookingforhealth-uk.com/healthier-catering.php.

 

 

Table 1

Menu item	Calories per portion	Protein g per portion	Carbohydrate g per portion	Total fat g per portion	Saturated fat g per portion	Salt g per portion
Starter	568	29.8	35.6	34	16.5	1.15
Main course	934	42.2	74.4	33.1	14.6	1.84
Dessert	475	5.5	18.8	18.1	11.1	0.15
Drink	139	0	35	0	0	0
Total	2116	77.5	163.8	85.2	42.2	3.14
Gov guideline	2000 kcal	45 g/day (women) 55 g/day (men)	267 g per day	78 g per day	22 g per day	6 g per day
% of guidelines	106%	171% (women) 141% (men)	61%	109%	192%	52%

 

 

 

Cinnamon – spice up your health

Cinnamon comes from the inner bark of evergreen trees (Cinnamomum verum, C. zeylandicum, C. aromaticum), native to Sri Lanka and other Asian countries.  The bark is peeled away from the tree and curls up into tubes, called quills, as it dries.

 

 

In addition to its use as a spice, cinnamon or its oil is used as a flavouring agent in pharmaceutical, personal health and cosmetic products.

Cinnamon is one of the oldest spices known.  It was imported to Egypt from China as early as 2000 BC, where it was used as a medicinal herb, a flavouring for drinks and as an embalming agent.  At one time it was considered to be even more valuable than gold.  Cinnamon is also mentioned in the Bible.

Moses was commanded:

“Take thou also unto thee principal spices, of pure myrrh five hundred shekels, and of sweet cinnamon half so much, even two hundred and fifty shekels, and of sweet calamus two hundred and fifty shekels” (Exodus 30:23)

 

In Proverbs, the lover says:

“I have perfumed my bed with myrrh, aloes, and cinnamon” (Proverbs 7:17)

And Solomon describes the beauty of his beloved as

“Spikenard and saffron; calamus and cinnamon, with all trees of frankincense; myrrh and aloes, with all the chief spices” (Song of Solomon 4:14)

The Roman Emperor Nero is said to have burned a year’s supply of cinnamon at the funeral for his wife Poppaea Sabina in 65 AD, to express the depth of his loss.

As its popularity grew, cinnamon was one of the first spices to be traded regularly between Europe and the Near East.

 

Cinnamon has many medicinal uses.  It is reported to be beneficial in the treatment of arthritis, asthma, cancer, diarrhoea, fever, heart problems, insomnia, menstrual problems, peptic ulcers, psoriasis, and spastic muscles.  Some of the confirmed effects of cinnamon are as a sedative for smooth muscle, circulatory stimulant, digestive aid, antibiotic, anticonvulsant, diuretic and antiulcerative.

Some studies suggest that cinnamon may be useful for people with diabetes.  In one trial, 1 to 6 grams of cinnamon taken daily for forty days reduced fasting blood glucose by 18 to 29 per cent, triglycerides by 23 to 30 per cent, LDL cholesterol by 7 to 27 per cent, and total cholesterol by 12 to 26 per cent.  In contrast, there were no clear changes for the subjects who did not take cinnamon[1].

Another trial showed that a cinnamon extract had a moderate effect in reducing fasting plasma glucose concentrations in diabetic patients with poor glycaemic control[2].

Other research has shown that a substance in cinnamon called methylhydroxychalcone acts as an insulin mimetic; it stimulated glucose uptake and glycogen synthesis to a similar level as insulin[3].

Cinnamon may thus be useful for helping to treat insulin resistance and type 2 diabetes, conditions that are becoming increasingly more common in the UK and elsewhere.

Statistics published in the Journal of Epidemiology and Community Health in February 2009 indicate that the incidence of diabetes in the UK climbed 74 per cent between 1997 and 2003.  By 2005, over 4 per cent of the population were classified as having some type of diabetes.  The majority of new cases are type 2 diabetes, linked to diet and growing obesity rates. A research team from Spain and Sweden analysed the results, and made it clear that the trend was not due to more screening tests or an ageing population.

Ideas for incorporating cinnamon into your diet

• Add 1 tsp ground cinnamon to oat porridge at breakfast
• Drizzle flaxseed oil over whole-wheat toast and then sprinkle with cinnamon and a little rice malt syrup
• Simmer a cinnamon stick with 1 cup rice milk  for a delicious warm drink
• Add a cinnamon stick to home-made squash soup to make a warming lunchtime meal
• When poaching fish, add cinnamon sticks to the poaching liquid
• Add ground cinnamon when preparing curries or spicy Middle Eastern dishes using chickpeas
• Add ground cinnamon to stewed apple and mix with ground almonds for a creamy dessert

 

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References

[1] Khan et al. Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes.  Diabetes Care 26:3215-3218, 2003

[2] Mang et al. Effects of a cinnamon extract on plasma glucose, HbA_1c, and serum lipids in diabetes mellitus type 2 European Journal of Clinical Investigation:Volume 36(5)May 2006p 340-344

[3] Jarvill-Taylor et al.  A Hydroxychalcone Derived from Cinnamon Functions as a Mimetic for Insulin in 3T3-L1 Adipocytes. Journal of the American College of Nutrition, Vol. 20, No. 4, 327-336 (2001)